1841481074 NPI number — MARUJA DEL VALLE DIAZ ARJONILLA MD

Table of content: MARUJA DEL VALLE DIAZ ARJONILLA MD (NPI 1841481074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841481074 NPI number — MARUJA DEL VALLE DIAZ ARJONILLA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAZ ARJONILLA
Provider First Name:
MARUJA
Provider Middle Name:
DEL VALLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIAZ ROMERO
Provider Other First Name:
MARUJA
Provider Other Middle Name:
DEL VALLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1841481074
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2212 E 4TH ST STE 304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92705-3873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-288-3230
Provider Business Mailing Address Fax Number:
714-571-7719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2212 E 4TH ST STE 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-288-3230
Provider Business Practice Location Address Fax Number:
714-571-7719
Provider Enumeration Date:
08/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  A97144 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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